Challenges for beta-blockers as first-line therapy for elderly hypertensive patients

The prevalence of hypertension increases with age. With aging, many physiologic changes must be considered with treatment. Concerns remain about the appropriateness of beta-blocker therapy in the elderly, even though many of these are unsubstantiated, and evidence exists to support beta-blocker use. A literature search reveals that beta-blockers and nonpharmacologic interventions are effective in the elderly. Although no well-designed, long-term, large-scale, clinical trials exist that assess outcomes for beta-blockers as monotherapy for treating hypertensive elderly patients, this fact should not deter their use in combination therapy, especially for those with comorbid diseases such as angina, myocardial infarction, and heart failure.